Summary
Overview
Work History
Education
Skills
Timeline
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Suzette Silva

Lubbock,TX

Summary

Dynamic Authorization Specialist with extensive experience at Centene, recognized for streamlining prior authorization processes and enhancing productivity through exceptional communication skills. Proven track record in leveraging medical terminology expertise and ensuring HIPAA compliance, contributing to superior service quality. Highly regarded for effective training capabilities and adept problem-solving in fast-paced environments.

Overview

9
9
years of professional experience

Work History

Authorization Specialist III

Centene
Lubbock, TX
10.2024 - Current
  • Reviewed authorization requests for accuracy and completeness.
  • Researched patient eligibility, coverage information, and benefit levels.
  • Maintained current knowledge of applicable regulations, laws, and standards.
  • Processed prior authorization requests in accordance with departmental guidelines.
  • Generated monthly reports detailing productivity metrics such as number of authorizations processed per day, week, month.
  • Act as a subject matter expert, as well as a trainer to other team members, for the overall authorization process and for multiple service types at different levels of urgency.

Lead BH Referral Specialist

Centene
Austin, TX
04.2018 - 10.2023
  • Records all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application, including customer interactions, details of inquiries, complaints, comments, and final resolution.
  • Adheres to quality standards, regulations, and confidentiality through the various communication channels.
  • Complies with all policies and standards.
  • Take escalation calls to help resolve provider issues in regard to their authorization requests.
  • Take calls from providers with various authorization questions, as well as take inpatient information in order to build a requested authorization for BH National - 27 markets, all LOB (Medicare, Medicaid, and Ambetter).
  • Process the authorization request that came in via Filenet, Faxcom, and TCA.
  • Participates in special projects as needed.
  • Performs other duties as assigned.

Customer Service Representative

Cenpatico Behavioral Health
Austin, TX
04.2016 - 04.2018
  • Assesses and researches routine member and/or provider inquiries, requests, and/or concerns to determine causes, and initiates corrective actions to other service or technical departments for follow-up as needed.
  • Mitigates and prevents complaints from being escalated to resolve in the initial contact.
  • Serves as the front-line resolution advocate for various member and/or provider inquiries, requests, or concerns.
  • Provides support on various member or provider issues to ensure that customers receive high-quality service.
  • Maintains performance and quality standards based on established contact center metrics.
  • Provides customer service in a high-paced contact center environment over the phone, via live chats, and emails.
  • Documents all member, or provider information, and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications.
  • Calls were received on the English and Spanish lines.

Education

High School Diploma -

Ralls High School
Ralls, TX
05-1988

Political Science

Texas Tech University
Lubbock, TX

Skills

  • Prior authorization processing - Medical and BH
  • Medical terminology expertise
  • HIPAA compliance
  • Effective communication skills
  • Microsoft office
  • Medicaid Medicare Ambetter

Timeline

Authorization Specialist III

Centene
10.2024 - Current

Lead BH Referral Specialist

Centene
04.2018 - 10.2023

Customer Service Representative

Cenpatico Behavioral Health
04.2016 - 04.2018

High School Diploma -

Ralls High School

Political Science

Texas Tech University

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Suzette Silva